Diabetes and self-monitoring blood sugar levels
Diabetes occurs when the body does not produce enough insulin or respond well to insulin. This makes it harder for the body to process sugar in the blood, causing serious health problems. Cancer patients with diabetes may need specialized care.
There are three main types of diabetes found in cancer patients.
Secondary diabetes is diabetes that develops because of an underlying condition or medication. It is the most common type of diabetes in cancer patients. It can be caused by certain cancer treatments. These include chemotherapy, immunotherapy, steroids, surgery and targeted therapy. Patients who get nutrition through a feeding tube or an IV are also at risk. Inflammation and infection can also cause secondary diabetes.
In most cases, secondary diabetes goes away when treatment is done. For some patients, especially those with risk factors for diabetes, the condition may remain after treatment or progress to Type 2 diabetes.
Secondary diabetes in cancer patients is treated with dietary changes, oral medications and/or insulin injections.
The other two types of diabetes are usually diagnosed before the patient’s cancer, though sometimes cancer treatments can contribute to their development.
Type 2 diabetes impacts about 20% of cancer patients. It occurs when the pancreas produces insulin, but cells do not respond well to it. This is known as insulin resistance. Obesity is a major cause of insulin resistance. Type 2 diabetes can be managed with healthy eating, regular exercise (five to seven days a week), oral medications and/or insulin injections.
Type 1 diabetes is a rare condition. It occurs when the pancreas produces no insulin or too little insulin to process blood sugar. Type 1 diabetes is typically diagnosed in patients under 30. Some forms develop in patients in their 50s and 60s. In cancer patients, certain treatments, such as a complete pancreatectomy (removal of the pancreas) or immunotherapy-induced diabetes, can result in Type 1 diabetes.
Diabetes and Cancer
Some research shows that cancer patients with Type 1 or Type 2 diabetes and high blood sugar (or hyperglycemia) have worse outcomes compared to cancer patients without diabetes. The link between cancer and diabetes is still being explored.
Most cancer patients with Type 1 or Type 2 diabetes need to adjust their medication during treatment. These changes should account for differences in appetite and activity levels, as well as the impact of cancer treatments.
Even in patients who do not have diabetes, hyperglycemia can contribute to infections and make it harder for the body to heal wounds. In some cases, it can delay surgery and disqualify patients from clinical trials.
Some treatments, including steroids and certain chemotherapy drugs, can cause hyperglycemia, so it is important for patients to monitor and control blood sugar during cancer treatment. Patients with hyperglycemia may need medications or insulin therapy.
Diabetes care at MD Anderson
Diabetes and hyperglycemia in cancer patients require precise management and care coordination, especially for patients who are hospitalized. MD Anderson has a team of physicians, advanced practice providers and educators trained to manage diabetes and hyperglycemia in cancer patients. Inpatients and outpatients at MD Anderson with diabetes or hyperglycemia can discuss a referral for diabetes care with their primary care team.
Diabetes care at MD Anderson is overseen by the Glycemic Management Program. The program ensures that cancer patients with diabetes receive patient-centered, quality care that is safe, timely, effective and efficient.
The program’s team includes physicians, advanced practice providers, pharmacists, nurses, informatics specialists and analysts. They work together to offer resources, data and education to MD Anderson teams to help improve glycemic management for patients at all stages of care. The Glycemic Management Program follows the best practice standards outlined by the Joint Commission for Advanced Diabetes Certification process and the American Diabetes Association guidelines.
When I first joined the faculty at MD Anderson in 2012, I didn’t really intend to stay, even though I was one of only two diabetes specialists on staff here, and the need was great for my area of expertise.
My husband is also a physician, and he had just been matched with a fellowship program in California. So, my original plan was to work at MD Anderson for a year and then join him on the West Coast, where we would come up with a final destination for our family.
I ended up liking the job here so much, though, that I really wanted to stay. Fortunately, my husband was able to find a great job in Houston, too, after his fellowship ended. So, here we still are, 11 years later. And I still really love what I do.
The best part of my job: giving patients back some control
The best part of managing diabetes in a place like MD Anderson is that it allows me to give patients back some measure of control over their lives.
Most patients can’t really do anything to resolve their own cancers, other than agreeing to undergo cancer treatment.
But with diabetes, patients can take more ownership of their disease. And they can see almost immediate improvement in their blood sugar levels if they’re willing to make changes to their diet and exercise routines and take prescribed medications.
Helping cancer patients with diabetes manage their blood sugar levels isn’t just good for their morale. Well-controlled sugars also can make the difference between being able to have surgery as soon as they need it, qualifying for a clinical trial or continuing a particular therapy — or not. Diabetes also puts people at higher risk for additional cancers. So, controlling blood sugars in cancer patients is critically important.
How I’ve dealt with ageism
I guess I look a little young for my age, because occasionally, new patients or their family members will assume I’m a nurse or a trainee when I walk in, despite my white lab coat. Sometimes, they’ll say I’m too young to be a doctor.
When that happens, I just smile and explain politely that I’m older than they think and that I’ve already been a physician for this many years. Then I’ll show them my MD Anderson badge, tell them my specialty and explain why I’ve been asked to come see them.
I approach things this way, in part, because I feel like you have to give people the benefit of the doubt. So many people walk into and out of patients’ rooms over the course of a single day that it really can be hard to keep track of who everyone is.
How being multilingual has benefitted me — and my patients
I’ve also noticed how much knowing different languages has benefitted me at MD Anderson. It really helps me connect with my patients.
Languages have always come easily to me, and I love to learn them. But I didn’t speak English fluently when I moved to the United States from Bahrain as an 8-year-old. Still, by the time I got to college, I was able to pursue a double-major in biology and Spanish and earn both degrees in just three years. In addition to English and Spanish, I also speak Hindi and Gujarati, an Indian dialect with roots in Arabic.
Many Latinx patients are surprised to hear me speak Spanish fluently. But I love seeing the relief on their faces when they realize they can comfortably communicate with me about their conditions in their own preferred language. That makes life so much easier — for both of us.
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